Skip to main content
SpringerLink
Log in

Measuring cardiovascular disease risk factor levels: International comparisons between Bremen-North/West (Germany) and two southeastern New England (USA) cities

Untersuchung von kardiovaskulären Risikofaktoren: Internationaler Vergleich zwischen Bremen-Nord/West (Deutschland) und zwei Städten im Südosten Neu-Englands (USA)

Examen des facteurs de risque cardio-vasculaire: Comparaison internationale entre la ville de Brème (nord-ouest l'Allemagne) et deux villes du sud-ouest de la Nouvelle-Angleterre (USA)

  • Published:
Sozial- und Präventivmedizin

Summary

Cardiovascular disease risk factor comparisons were made on study populations from communities in two different countries with similar ongoing intervention programs. Baseline survey data from the intervention and comparison communities of the Pawtucket Heart Health Program in Pawtucket, Rhode Island, and from the intervention Region of Bremen-North/West of the German Cardiovascular Prevention Study were compared with respect to these cardiovascular disease risk factors: smoking, overweight, physical inactivity, hypertension, and hypercholesterolemia. The relationship between these variables and social class was also examined in an attempt to partially explain some of the cross cultural differences in risk factors and predicted CHD and CVD mortality. Results indicated statistically significant differences in amount of cigarettes smoked, exercise frequency, diet, body mass index, total cholesterol, HDL, and blood pressure. These risk factors were generally higher in the German population than in the American population as were the predicted CHD and CVD mortality. For the study populations of both countries, however, the lower the social class, the more prevalent the smoking, excess weight, and lack of physical activity.

Zusammenfassung

Die Prävalenz kardiovaskulärer Risikofaktoren wurde in Studienpopulationen aus Gemeinden in zwei Ländern mit einem ähnlíchen Interventionsprogramm untersucht. Daten der Baseline-Surveys für das Pawtucket Heart Health Program in Pawtucket, Rhode Island, und des Bremer, Teils der Deutschen Herz-Kreislauf-Präventionsstudie wurden im Hinblick auf die folgenden kardiovaskulären Risikofaktoren analysiert: Rauchen, Übergewicht, Bewegungsmangel, Bluthochdruck und Hypercholesterinämie. Ausserdem wurde der Zusammenhang zwischen diesen Variablen und der Sozialschichtzugehörigkeit untersucht, um Erklärungen für die Unterschiede in der Risikofaktorenprävalenz sowie der prognostizierten kardiovaskulären Mortalität liefern zu können. Es ergaben sich statistisch signifikante Unterschiede zwischen den beiden Ländern für das Zigarettenrauchen, die körperliche Aktivität, das Ernährungsverhalten, den Body-Mass-Index, das Gesamtcholesterin, das HDL-Cholesterin und den Blutdruck. Diese Risikofaktoren wiesen alle für die deutsche Studienpopulation eine höhere Prävalenz auf als für die amerikanische Vergleichspopulation. Für beide Studienpopulationen zeigte sich übereinstimmend, dass die Risikofaktoren Rauchen, Übergewicht und Bewegungsmangel einen starken sozialen Gradienten aufweisen.

Résumé

La prévalence des facteus de risque cardio-vasculaire a été examinée dans les populations de municipalités de deux pays ayant des programmes d'intervention similaires. Les données de l'enquête initiale du programme cardiova-vasculaire Pawtucket, au Pawtucket, Rhode Island, et celle de la partie de Brème de l'étude allemande de prévention des maladies cardio-vasculaires a été analysée pour les facteurs de risque cardio-vasculaire suivant: Le fait de fumer, l'excès de poids, le manque de mouvement, l'hypertension artérielle et l'hyperpercholestérolémie. En outre la relation entre ces variables et la couche sociale a été examinée afin de pouvoir trouver des explications aux différences de prévalence des facteurs de risque ainsi, qu'aux différences de la mortalité Cardio-vasculaire prévue. On trouve des différences statistiquement significatives entre les 2 pays pour le fait de fumer la cigarette, l'activité physique, le comportement alimentaire, l'indexe de poids corporel, le cholestérol total, le HDL-cholestérol et la tension artérielle. Tous ces facteurs de risque avaient une prévalence plus élevée dans la population allemande que dans la population américaine. Un fort gradient social est montré clairement dans les 2 populations pour les facteurs de risque suivant: le fait de fumer, l'excès de poids et le manque de mouvement.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Higgins, MW. The Framingham Heart Study: Review of epidemiological design and data, limitations and prospects. In: Genetic Epidemiology of Coronary Heart Diseases: Past, Present, and Future. New York: Alan R. Liss, Inc., 1984:51–64.

    Google Scholar 

  2. Multiple Risk Factor Intervention Trial Research Group. Risk Factor Changes and Mortality Results. JAMA 1982;248:1465–1477.

    Google Scholar 

  3. The Lipid Research Clinic Coronary Primary Prevention Trial Results. JAMA 1984;251:351–374.

    Google Scholar 

  4. Carleton RA, Lasater TM, Assaf AR, Lefebvre RC, McKinlay SM. The Pawtucket Heart Health Program: An Experiment in Population-Based Disease Prevention. RI Medical Journal 1987;70:533–538.

    Google Scholar 

  5. Lasater TM, Abrams D, Artz L, et al. Lay Volunteer Delivery of a Community-Based Cardiovascular Risk Factor Change Program: The Pawtucket Experiment. In: Matarazzo J.D., Miller N.E., Weiss S.M., et al., eds. Behavioral Health: a Handbook of Health Enhancement and Disease Prevention. Silver Spring MD: John Wiley, 1984:1166–1170.

    Google Scholar 

  6. Lasater TM, Lefebvre RC, Carleton RA. The Pawtucket Heart Health Program: Community Level Programming for Heart Health. RI Medical Journal 1988;71:31–34.

    Google Scholar 

  7. Assaf AR, Banspach SW, Lasater TM, McKinlay SM, Carleton RA. The Pawtucket Heart Health Program: Evaluation Strategies. RI Medical Journal 1987;70:541–546.

    Google Scholar 

  8. GCP Study Group. The German Cardiovascular Prevention Study (GCP): Design and Methods. European Heart Journal, 1988;9:1058–1066.

    Google Scholar 

  9. Herman B, Greiser E, Helmert U, et al. Prevalence of Cardiovascular Disease Risk Factors in the City of Bremen—The 1984 Bremen Baseline Health Survey of the German Cardiovascular Prevention Study. Soz Präventivmed 1987;32:31–38.

    Google Scholar 

  10. Helmert U, Herman B, Joeckel KH, Greiser E. Social Class and Risk Factors for Coronary Heart Disease in the Federal Republic of Germany. J Epidemiol Comm Health 1989;43:37–42.

    Google Scholar 

  11. Helmert U, Herman B, Klesse R, Greiser E. Prävalenz und Behandlungsstatus des Bluthochdruckes—Ergebnisse des 1. Bremer DHP—Gesundheitgssurveys (Hypertension Prevalence and Treatment Status—GCP Baseline Health Survey). Off Gesundh-wes 1987;49:621–627.

    Google Scholar 

  12. Farquhar JW. The communitybased Model of Lifestyle Intervention Trials. Am J Epidemiol 1987;108:103–111.

    Google Scholar 

  13. Blackburn H, Leupker RV, Kline FG, et al. The Minnesota Heart Health Program: A Research and Demonstration Project in Cardiovascular Disease Prevention. In: Matarazzo J. D., Miller N. E., Weiss S. M., et al., eds. Behavioral Health: A Handbook of Health Enhancement and Disease Prevention. Silver Spring MD: John Wiley, 1984: 1171–1178.

    Google Scholar 

  14. Puska P, Tuomilehto J, Salonen J, et al. Community Control of Cardiovascular Diseases: The North Karelia Projection. Copenhangen: WHO Regional Office for Europe, 1981.

    Google Scholar 

  15. McKinlay SM, Kipp DM, Johnson P, et al. A Field Approach for Obtaining Physiological Measures in Surveys of General Populations: Response Rates, Reliability, and Costs. In: Health Survey Research Methods: Proceedings of the Fourth Conference on Health Survey Reseach Methods, Washington, D. C.: 1982. DHHS Pub. No. (PHS) 84-3346 (September, 1984).

  16. McKinaly SM, McGraw SA, Assaf AR, et al. An Innovative Approach to the Evaluation of Large Community Programs. In: Proceedings of the Academy of Behavioral Medicine 1981–1982. W. Gordon, J. A. Herd, A. Baum, eds. Academic Press, in press.

  17. Siconolfi SF, Garber CE, Lasater TM andCarleton RA. A Simple, Valid Step Test for Estimating Maximal Oxygen in Epidemiologic Studies. Am J Epidemiol 1985;121:282–290.

    Google Scholar 

  18. Kish L. Survey Sampling. New York: John Wiley and Sons, 1984.

    Google Scholar 

  19. Deming WE. Sample Design in Business Research. New York: John Wiley and Sons, 1960.

    Google Scholar 

  20. U. S. Department of Commerce-Office of Federal Statistical Policy and Standards. Standard Occupational Classification Manual. 1980.

  21. The Lipid Research Clinics Program. The Coronary Primary Prevention Trial: Design and Implementation. J Chronic Dis 1979;32:609–631.

    Google Scholar 

  22. SAS Institute Inc. SAS User's Guide: Statistics., Version 5. Cary, NC.: SAS Institute Inc., 1985.

    Google Scholar 

  23. Cornoni-Huntly J, Barbano HE, Brody JA, et al. National Health and Nutrition Examination I—Epidemiologic Follow-up Survey. Public Health Reports 1983;98:245–251.

    Google Scholar 

  24. Guademaris R, Folsom AR, Prineas RJ, Luepker R. The Random-zero Versus the Standard Mercury Sphygmomanometer: A Systematic Blood Pressure Difference. Am J Epidemiol 1985;121:282–290.

    Google Scholar 

  25. Kraus JF, Borhani NO, Franti CE. Socioeconomic Status, Ethnicity, and Risk of Coronary Heart Disease. Am J Epidemiol 1980;111:407–414.

    Google Scholar 

  26. Shekell RB, Ostfeld AM, Paul O. Social Status and Incidence of Coronary Heart Disease. J Chronic Dis 1969;22:381–394.

    Google Scholar 

  27. Remington PL, Forman MR, Gentry EM, et al. Current Smoking Trends in the United States. The 1981–1983 Behavioral Risk Factor Surveys. JAMA 1985;253:2975–2978.

    Google Scholar 

  28. Borgers D, Menzel R. Wer raucht am meisten? Die Analyse des Zigarettenkonsums in der Bundesrepublik nach Berufen. Muench med Wschr 1984;126:1092–1096.

    Google Scholar 

  29. Jacobsen BK, Thelle DS. Risk Factors for Coronary Heart Disease and Level of Eduction. Am J Epidemiol 1988;127:923–932.

    Google Scholar 

  30. La Vecchia C, Gutzwiller F, Wietlisbach V. Sociocultural Influences on Smoking Habits in Switzerland. Int J Epidemiol 1987;4:624–626.

    Google Scholar 

  31. Folsom AR, Caspersen CJ, Taylor HL, et al. Leisure Time Physical Activity and Its Relationship to Coronary Risk Factors in a Population-based Sample. The Minnesota Heart Survey. Am J Epidemiol 1985;121:570–579.

    Google Scholar 

  32. Salonen JT, Puska P, Tuomilehto J. Physical Activity and Risk of Mycocardial Infarction, Cerebral Stroke and Death. A Longitudinal Study in Eastern Finland. Am J Epidemiol 1982;115:526–537.

    Google Scholar 

  33. Holme I, Helgeland A, Hjermann I, et al. Coronary Risk Factors and Socioeconomic Status: The Oslo Study. Lancet 1976;2:1396–1398.

    Google Scholar 

  34. Leon AS, Conett J, Jacobs DR, Rauramaa R. Leisure-time Physical Activity Levels and Risk of Coronary Heart Disease and Death. The Multiple Risk Factor Intervention Trial. JAMA 1987;258:2388–2395.

    Google Scholar 

  35. Procock SJ, Shaper AG, Cook DG, et al. Social Class Differences in Ischemic Heart Disease in British Men. Lancet 1987; II:197–201.

    Google Scholar 

  36. National Center for Health Statistics. Vital and Health Statistics, Series 10, No. 121. Characteristics of Persons with Hypertension. United States, 1974. DHEW Publication No (PH) 79-1549. Washington DC; US GPO, November 1978.

    Google Scholar 

  37. Hypertension Detection and Follow-up Cooperative Group. Race, Education and Prevalence of Hypertension. Am J Epidemiol 1977;106:351–361.

    Google Scholar 

  38. Schweizerisches Nationales, Forschungsprogramm 1A. Die Epidemiologie der Risikofaktoren für kardiovaskuläre Krankheiten in der Schweiz. Schweiz Med Wochenschr 1981;12 (suppl.):5–62.

    Google Scholar 

  39. Härtel U, Keil U. Psychosoziale Faktoren und Herz-Kreislauf-Erkrankungen. Fortschr Med 1986;104:943–947.

    Google Scholar 

  40. Barsky AJ. The paradox of health. N Engl J Med 1988;318:414–418.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Health Education, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island

    Annlouise R. Assaf, Thomas L. Lasater & Richard A. Carleton

  2. Department of Community Health, Brown University Program in Medicine, Providence, Rhode Island

    Annlouise R. Assaf & Thomas L. Lasater

  3. Division of Epidemiology, Bremen Institute for Prevention, Research and Social Medicine (BIPS), P. O. Box 106767, D-28067, Bremen

    Uwe Helmert & Eberhard Greiser

  4. Department of Medicine, Memorial Hospital of Rhode Island and Brown University, Pawtucket and Providence, Rhode Island

    Richard A. Carleton

Authors
  1. Annlouise R. Assaf
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Uwe Helmert
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Thomas L. Lasater
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Richard A. Carleton
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eberhard Greiser
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Assaf, A.R., Helmert, U., Lasater, T.L. et al. Measuring cardiovascular disease risk factor levels: International comparisons between Bremen-North/West (Germany) and two southeastern New England (USA) cities. Soz Präventivmed 40, 218–229 (1995). https://doi.org/10.1007/BF01354476

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01354476

Keywords

Search

Navigation